CN103338727A

CN103338727A - Interbody spinal implants with modular add-on devices

Info

Publication number: CN103338727A
Application number: CN2012800064765A
Authority: CN
Inventors: W·D·阿姆斯壮; J·邓肯; A·J·麦尔肯特
Original assignee: Warsaw Orthopedic Inc
Current assignee: Warsaw Orthopedic Inc
Priority date: 2011-01-27
Filing date: 2012-01-26
Publication date: 2013-10-02
Anticipated expiration: 2032-01-26
Also published as: WO2012103351A2; EP2667826A2; CN103338727B; EP2667826A4; WO2012103351A3; US20120197401A1

Abstract

An implant assembly for a spinal column includes at least an interbody element and an add-on element that is removably attachable to the add-on element to form an implant assembly. At least a portion of the add-on element is positionable in a space between vertebrae along with the interbody element to support the vertebrae.

Description

Have spinal implant between the vertebral body of modularity attachment device

Background

The present invention generally relates to spinal implant between the vertebral body that has the modularity attachment device, and relates to for the method and apparatus of implanting spinal implant between vertebral body.

Developed for some kinds of devices stablizing spine and be conducive to merge at each level place of spine and system.Comprise the skeletal structure, vascular structure, neuromechanism, muscular tissue of vertebral body and make along the anatomy of spine body of other vital tissue of spinal column and be difficult to be positioned at implants in vivo in the intervertebral disc space between the adjacent vertebral bodies or engage plate between the adjacent vertebrae.In addition, in the time of in implant is placed in intervertebral disc space, implant is used for entering the groove of intervertebral disc space or passage and provides passage for implant from the retrograde movement of intervertebral disc space.In the anatomy of spine body and implant rear end can make with respect to the fluctuation in the position of adjacent vertebral bodies and plate is attached to implant and/or adjacent vertebral bodies is difficult to realize.

Therefore, need be between vertebral body fusion implant and insert extra improvement in apparatus and the technology so that for the surgeon provides motility in the art, so that implant and implanted prosthetics are adjusted to suitable patient demand.

General introduction

According to an aspect, disclose a kind ofly for spinal implant assembly between the vertebral body of spinal column, it comprises element between vertebral body in the space that can be positioned between vertebra and the add ons, add ons is fixed to the rear end of element between vertebral body so that the implant assembly to be provided.Add ons can be configured to reside in fully or basically in the space between the vertebra.Add ons can be configured to also comprise that one or more apertures are to admit the one or more bone anchors that is used for the implant assembly is fixed to vertebra.In certain embodiments, add ons comprises at least one projection with at least one aperture, and projection is configured to reside in or basically in the space between vertebra.In other embodiments, add ons comprises at least one projection, and space and the one or more outer surface along vertebra that this at least one projection is configured between vertebra extend.In a further embodiment, add ons comprises at least one projection, the space that this at least one projection is configured between vertebra extends into the recess that is formed at the vertebra, makes projection complete or recessed to form no profile or slim layout basically with respect to the outer surface of vertebra.

According to another aspect, disclose implant assembly between a kind of vertebral body and be used for the method for spinal implant between the assembling vertebral body, this implant comprises the add ons that is attached to element between vertebral body removedly.Element comprises interface fit part and add ons is fixed to the receiving portion of the rear end of element between vertebral body between add ons and vertebral body.Inserter can be provided, and element and add ons are to be conducive in the space between the implant assembly insertion vertebra between the vertebral body of its joint assembling.Inserter can comprise the body that has guider, and guider provides the passage that aligns with the aperture of add ons to be conducive to the forming hole in vertebra, and this hole is used for admitting bone anchors and/or guiding bone anchors to enter in the vertebra along required track.Also described the reamer guider, it comprises the guider body to guide reamer in the shaping recess in vertebra, and is slim or when not having profile and arranging, the shaping recess is admitted the projection of extending from add ons when hope.

Correlated characteristic of the present invention, aspect, embodiment, purpose and advantage will be apparent from following description.

Brief description

Fig. 1 is the perspective view of an embodiment of element between the vertebral body of spinal implant assembly.

Fig. 2 is the perspective view of an embodiment that can be attached to the add ons of element between vertebral body shown in Figure 1.

Fig. 3 is the enlarged perspective of the coupling part of element between vertebral body shown in Figure 1.

Fig. 4 is the magnification fluoroscopy part of the mating part of add ons shown in Figure 2.

Fig. 5 A-5C shows the perspective view that is connected of element between add ons and vertebral body shown in Figure 1.

Fig. 6 A-6D shows the various views of the add ons shown in Figure 2 that is attached to element between vertebral body shown in Figure 1 in spinal column segment.

Fig. 7 is the perspective view that can be attached to another embodiment of the add ons of element between vertebral body shown in Figure 1.

Fig. 8 A-8D shows the various views of the add ons shown in Figure 6 that is attached to element between vertebral body shown in Figure 1 in spinal column segment.

Fig. 9 A-9D is to admit the various views of the method and apparatus of element between add ons shown in Fig. 8 A-8D and vertebral body for the preparation of vertebra.

Figure 10 A-10D is that wherein inserter comprises for the guider of guiding bone anchors by the aperture of add ons for element and the insertion apparatus of add ons and the various views of method between vertebral body shown in insertion Fig. 8 A-8D.

Figure 11 A-11D shows the various views of another embodiment that is attached to the add ons of element between vertebral body shown in Figure 1 in spinal column segment.

Figure 12 A-12F is the various views of spinal column segment, shows for the preparation of vertebra with slim or do not have a method and apparatus that profile is admitted element between add ons shown in Figure 11 A-11D and vertebral body in arranging.

Figure 13 A-13D shows the various views of another embodiment that is attached to the add ons of element between vertebral body shown in Figure 1 in spinal column segment.

Figure 14 A-14C is that wherein inserter comprises for the guider of guiding bone anchors by the aperture of add ons for the various views of another embodiment of the insertion apparatus of element and add ons between vertebral body shown in insertion Figure 13 A-13D and method.

Figure 15 A-15D shows the various views of another embodiment that is attached to the add ons of element between vertebral body shown in Figure 1 in spinal column segment.

Figure 16 A-16D shows the various views of another embodiment that is attached to the add ons of element between vertebral body shown in Figure 1 in spinal column segment.

Figure 17 A-17D shows the various views of another embodiment that is attached to the add ons of element between vertebral body shown in Figure 1 in spinal column segment.

Figure 18 is the perspective view that can be attached to another embodiment of element between the vertebral body of add ons disclosed herein.

The description of specific embodiment

In order to help to understand principle of the present invention, referring now to embodiment illustrated in the accompanying drawings, and will use specific language to describe these embodiment.But should be understood that this is not that intention limits the scope of the invention.As the technical staff in field involved in the present invention will expect usually, it is contemplated that any this type of modification in graphic display unit and further revise, and this type of further application of principle of the present invention as shown here.

Provide method, technology, apparatus and implant with that subside, that part is that subside, that damage, ill or otherwise impaired intervertebral disc space recover and/or remain on required intervertebral disc space height and adjacent soleplate orientation.The space that provides method, technology, apparatus and implant to recover and/or keep being formed by one or more vertebras that remove and the intervertebral disc that is associated.Path to implant site can be single port, twoport or many mouthfuls.Apparatus and implant also can be used in the anterior lateral cervical approach of implant site, but it is also contemplated that other approach, outside approach, posterolateral approach, oblique road, rear approach and outside approach before comprising.In addition, the method for surgery, technology, apparatus and implant can be applicable to all vertebra sections of vertebra, comprise the zone of lumbar vertebra, thoracic vertebra and cervical vertebra.

Fig. 1 shows the perspective view of implanting construction element 20 between vertebral body, implant construction element 20 between vertebral body and can be positioned on the endplate between the adjacent vertebral, to replace an intervertebral disc space to merge single movement sections (motion level) or time to cut one or more vertebras of replacing a plurality of intervertebral disc spaces in the operation and being associated entirely to merge a plurality of sections vertebral body.Fig. 2 shows an embodiment of add ons 40, add ons 40 can the rear end of element between vertebral body 20 or near join between vertebral body element 20 to form implant assembly 60, for example shown in Fig. 5 C and Fig. 6 A-6D.Add ons described herein can be fully or is fully placed intervertebral disc space basically, and/or add ons can comprise the part of extending along one or more vertebras of intervertebral disc space outside outside intervertebral disc.The intervertebral disc of add ons extend outward the part can be recessed into adjacent vertebrae front surface to provide slim or not have the profile configuration, perhaps be positioned at adjacent vertebrae on outer surface.Add ons can comprise such feature: this feature is one or more for the soleplate that engages adjacent vertebrae, and/or admittance extends through add ons the implant assembly is fixed to the bone anchors of vertebra.

Element 20 comprises cage shape body between vertebral body, and this cage shape body has sidewall 22 that the opposite side at cavity 26 extends, 24 and extend and connect

sidewall

22,24 front bulkhead 28 between sidewall 22,24.Element 20 sizes are designed to be engaged in the intervertebral disc space between vertebral body V1, the V2 between

vertebral body.Sidewall

22,24 extends to relative rear end 23,25 from front bulkhead 28.Front bulkhead 28 can comprise that the nose of convex rounding is to be conducive to insert in the intervertebral disc space and the traction vertebral body.Front bulkhead 28 can be linear or rounded to form any suitable shape between

sidewall

22,24 as shown in the figure.Element 20 also can comprise bone composition surface 30 and sending down the fishbone composition surface 32 between vertebral body, and it has the projection that is tooth, ridge or other connected structure form to strengthen and the engaging of adjacent vertebral bodies soleplate.In the illustrated embodiment, projection 31,33 is extended across

sidewall

22,24 and front bulkhead 28, and in that 23,25 direction is spaced apart from each other to the rear end from front bulkhead 28.

Bone composition surface

30,32 can be the plane, convex curve, convergent, or otherwise is configured to be received between at least a portion of soleplate and contact at least a portion of this soleplate along at least a portion of the length of element between vertebral body 20.Element 20 also can comprise one or more cavitys or the hole of passing bone composition surface and sending down the fishbone composition surface and/or its side surface on it between vertebral body, to be conducive to the bone growth by element between vertebral body 20.

Sidewall

22,24 all extends to the rear end 23,25 corresponding one from front bulkhead 28, and also extends to sending down the fishbone composition surface 32 from last bone composition surface 30.

Sidewall

22,24 can be parallel to each other or relative to each other convergent with towards front bulkhead 28 convergence or disperse.

Wall

22,24,28 lateral surface can be when from above or below the plane, concave surface or convex surface when observing; 32 planes from last bone composition surface 30 to the sending down the fishbone composition surface, concave surface or convex surface; Perhaps their combination.

Fig. 2 shows an embodiment of add ons 40.Add ons 40 comprises slender body 42, and the size of slender body 42 is designed to extend and connect

sidewall

22,24 between the

sidewall

22,24 of element between vertebral body 20.Add ons 40 comprises towards and contacts the last bone composition surface 44 and relative sending down the fishbone composition surface 46 of the soleplate of vertebra.

Bone composition surface

44,46 includes at least one projection, ridge or the tooth from its extension.Add ons 40 also comprises towards outer surface 48 with relative towards interior surface 50.In the illustrated embodiment,

bone composition surface

44,46 comprises a series of protruding 47,49 respectively, and

projection

47,49 is spaced apart from each other across add ons 40 longitudinal extensions and in the direction from outer surface 48 inward faces 50.As Fig. 4 further shown in, co-operating

member

52,54 is protruding and be configured to as shown in Figure 3 be received in the

receiving portion

34,36 rear end 23,25 that is formed at element 20 between vertebral body to form spinal implant assembly 60 between vertebral body from inner surface 50.

Further referring to Fig. 5 A-5C, receiving

portion

34,36 includes side opening now, and wherein the side opening of receiving portion 34 extends through sending down the fishbone composition surface 32, and the side opening of receiving portion 36 extends through bone composition surface 30.For add ons 40 being fixed to element 20 between vertebral body, add ons 40 is rotated with orientation shown in Fig. 5 A, so that the corresponding corresponding orientation in bone composition surface 30 and the sending down the fishbone composition surface 32 up in the co-operating member 52,54.Add ons 40 is advanced towards element between vertebral body 20, shown in Fig. 5 B.Under this orientation, the median plane 41 of add ons 40 favours the median plane 21 of add ons 20.Add ons 40 is then rotated, so that

co-operating member

52,54 moves through corresponding receiving

portion

34,36 side opening and enter in the

receiving portion

34,36, shown in Fig. 5 C.Under this orientation, the median plane 21 of element 20 aligns between the median plane 41 of add ons 40 and vertebral body.In another embodiment, it is contemplated that element 20 can be provided with the co-operating member from its extension between vertebral body, and add ons 40 comprises for the receiving portion of admitting co-operating member.

In the illustrated embodiment,

co-operating member

52,54 comprises the outer end of expansion, as by shown in the outer end 52a of the expansion among Fig. 4, and the female between the inner surface 50 of the corresponding outer end that enlarges and add ons 40, as by shown in the female 52b of Fig. 4.Receiving

portion

34,36 includes corresponding shape, and it has enough wide inner groovy with in the outer end of admitting co-operating

member

52,54 expansion corresponding one, as by shown in the inner groovy 34a of Fig. 3.Receiving

portion

34,36 also comprises being dimensioned to separately admits the width of

co-operating member

52,54 corresponding female to reduce part, reduces shown in the part 34b as the width by Fig. 3.Width reduces the outer end 52a that part 34b is narrower than expansion, so that add ons 40 can not extract from element between vertebral body 20, receiving

portion

34,36 respective side opening are passed in the outer end that enlarges unless add ons 40 is rotated fully.Outer end 52a, the 54a that enlarges can make add ons keep and

sidewall

22,24 rear end 23,25 contiguous engagement, but do not get rid of inner surface 50 and rear end 23,25 spaced relationship.Structure after the assembling provides spinal implant assembly 60 between vertebral body, wherein cavity 26 by add ons 40 with

sidewall

22,24 and front bulkhead 28 sealing.Bone material, bone growth material or other suitable biocompatible materials can be placed cavity 26 to be conducive to fusion.

Referring to Fig. 6 A-6C, further show the spinal column segment SC with vertebral body V1 and the second vertebral body V2 and intervertebral disc space D.Implant assembly 60 is positioned among the intervertebral disc space D.Implant assembly 60 is positioned among the intervertebral disc space D, makes its front bulkhead 28 be positioned at the rear side place of intervertebral disc space D, and

sidewall

22,24 extends to its rear end 23,25 forward from front bulkhead 28, and add ons 40 is fixed to rear end 23,25 places.Implant assembly 60 is positioned among the intervertebral disc space D between vertebral body V1 and the V2, makes that implant assembly 60 contacts soleplate E1 and E2 when implanting orientation when it is in.Add ons 40 is located so that it is positioned at intervertebral disc space D fully, and with the aliging or be offset slightly backward from this surface towards outer front surface of vertebral body V1, V2.Therefore, add ons 40 provides slim for implant assembly 60 or has not had the profile surface, and this surface does not stretch out or stretching out forward towards front surface from vertebrae V 1, V2 from intervertebral disc space D.This allows

projection

47,49 to engage corresponding soleplate E1, E2 along bone composition surface 44,46.According to a kind of operation, implant assembly 60 is positioned in the intervertebral disc space D from direct anterior lateral cervical approach.As used herein, " directly anterior lateral cervical approach " is to be parallel to or to be arranged essentially parallel to sagittal plane and therefore to be orthogonal to or to be substantially normal to the approach of coronalplane.Other embodiment imagines implant assembly 60 and is positioned in the intervertebral disc space D from another approach such as the outside, rear or oblique road.

Fig. 7 shows and is attached to element 20 between vertebral body removedly with another embodiment of the add ons 140 that forms implant assembly 160, shown in Fig. 8 A-8D.Add ons 140 comprises slender body 142, and slender body 142 is dimensioned to and extends between the

sidewall

22,24 of element between vertebral body 20 and connection sidewall 22,24.Add ons 140 comprises towards and contacts the last bone composition surface 144 and relative sending down the fishbone composition surface 146 of corresponding one soleplate among vertebrae V 1, the V2.Area supported 144,146 includes at least one projection from its extension.Add ons 140 also comprises towards outer surface 148 with relative towards interior surface 150.Co-operating member 152,154 stretches out and is configured to be received in the receiving

portion

34,36 rear end 23,25 that is formed at element 20 between vertebral body shown in Fig. 8 A-8D from inner surface 150.In addition, add ons 140 comprises first aperture 156 and second aperture 158, first aperture 156 and second aperture 158 are positioned on the opposite side of median plane of add ons 140 and implant assembly 160, in order to admit bone anchors 162,164 respectively, thereby implant assembly 160 is anchored among vertebrae V 1, the V2 corresponding one.First aperture 156 is from 148 extending and pass towards interior surface 150 towards outer surface, and to head and angled towards sagittal plane, so that bone anchors 162 extends into epipyramis V1.Second aperture 158 is from 148 extending and pass towards interior surface 150 towards outer surface, and to afterbody and angled towards sagittal plane, so that bone anchors 164 extends into down vertebrae V 2.Add ons 140 comprises the projection that is a pair of spike 166 forms of extending from bone composition surface 144, and spike 166 aligns with first aperture 156 of extending from upper support surface 144 in the soleplate that embeds vertebrae V 1.When bone anchors 162 engage vertebrae V1, the soleplate E1 of vertebrae V 1 is towed to contact and embeds in the spike 166.Add ons 140 also comprises the projection that is a pair of spike 168 forms of extending from lower support surface 146, and spike 168 aligns with second aperture 156 in embedding vertebrae V 2.When bone anchors 164 engage vertebrae V2, the soleplate E2 of vertebrae V 2 is towed to contact and embeds in the spike 168.Holding element 170 is fixed to add ons 140 and is positioned between the aperture 156,158 on the outer surface 148.Holding element 170 can rotate allowing bone anchors to insert between aperture 156,158 primary importance and the second position with respect to add ons 140, at second position place, holding element 170 overlaps to prevent with the bone anchors that inserts or limits holdfast and 156,158 withdraw from from the aperture.

Fig. 9 A-9D show spinal column segment SC and reaming guider 100 and for the preparation of vertebrae V 1, V2 to admit the reamer 120 of the holdfast that extends from add ons 140.Reaming guider 100 comprises the body 102 that can be positioned among the intervertebral disc space D, at the guide rib 104 of the proximal end of body 102 and the central shaft 106 that extends to near-end shank (not shown) at near-end from guide rib 104.Guide rib 104 is included in first ramp way 108 at an axle side place of 106 and at second ramp way 110 at the opposite side place of axle 106.Reamer 120 comprises the slender axles 122 that extend to far-end reaming head 124 from near-end shank (not shown).Reaming head 124 can navigate in the ramp way 108,110 corresponding one and be directed among corresponding vertebrae V 1, the V2, be received among the intervertebral disc space D with the path that is formed for inserting and with add ons 140, make add ons not stretch out forward from intervertebral disc space D, thereby when implant assembly 160 is positioned among the intervertebral disc space D, form slim or do not have profile and arrange.

Figure 10 A-10D shows the insertion apparatus 200 that joins the implant assembly 160 that comprises element 20 between add ons 140 and vertebral body to.Insert apparatus 200 and comprise slender axles 202, it extends between the insertion head 206 of the far-end of near-end shank 204 and axle 202.Insert head 206 and be connected to axle 202 removedly, to allow assembled configuration for another embodiment of the insertion head of other embodiment of add ons.Yet, do not get rid of insertion head 206 and arrive the permanent attached of axle 202.Inserting head 206 comprises and the axle 202 guider body 208 of longitudinal extension alignedly.Body 202 is included in first ramp way 210 on its opposite side and second ramp way, 212, the

first ramp ways

210 and 212 alignment of second ramp way and forms corresponding one proximal extension portion in the bone anchors aperture 156,158 of add ons 140.Insert head 206 and also comprise relative finger piece 214,216, finger piece 214,216 is positioned in the groove 171,172 on the opposite side of add ons 140 (also can referring to Fig. 7 and Fig. 8 B) and enters in the groove 35,37 (also can referring to Fig. 5 A) along the sidewall 22 of element between

vertebral body

20,24 side direction to outer surface.The location of finger piece 214,216 in groove guarantees that passage 210,212 is with respect to suitably locating and align in the aperture 156,158 of add ons 140.Insert apparatus 200 and also comprise and can vertically move member 220, this member can move with slit 218 compression guide bodies 208 longitudinally and makes finger piece 214,216 towards mobile so that implant assembly 160 is clamped between the two each other along axle 202.Element 20 and add ons 140 are positioned under the situation in the space between the vertebra between vertebral body, and ramp way 210,212 is used for guiding bone anchors to prepare apparatus and/or bone anchors 162,164 and passes aperture 156,158 and enter among corresponding vertebrae V 1, the V2 with required angle.

Figure 11 A-11D shows and is attached to element 20 between vertebral body removedly with another embodiment of the add ons 240 that forms implant assembly 260.Add ons 240 comprises slender body 242, and slender body 242 sizes are designed to extend and connect

sidewall

22,24 between the

sidewall

22,24 of element between vertebral body 20.Add ons 240 comprises towards and contacts the last bone composition surface 244 and relative sending down the fishbone composition surface 246 of corresponding one soleplate among vertebrae V 1, the V2.Composition surface 244,246 include from its extension at least one tabular protruding 266,268.Add ons 240 also comprises towards outer surface 248 with relative towards interior surface 250.Co-operating member 252,254 stretches out and is configured to be received in the

receiving portion

34,36 rear end 23,25 that is formed at element 20 between vertebral body from inner surface 250.In addition, add ons 240 comprises first aperture 256 and second aperture 258, first aperture 256 and second aperture 258 are positioned to pass corresponding in the projection 266,268 on the median plane of add ons 240 and implant assembly 260, in order to admit bone anchors 162,164 respectively, implant assembly 260 is anchored to corresponding among vertebrae V 1, the V2.First aperture 256 to head inclination and on sagittal plane, be parallel to or be roughly parallel to sagittal plane, so that bone anchors 162 extends into epipyramis V1.Second aperture 258 to afterbody tilt and on sagittal plane, be parallel to or be roughly parallel to sagittal plane, so that bone anchors 164 extends into down vertebrae V 2.Holding element 270 is fixed to add ons 240 and is positioned between the aperture 256,258 on the outer surface 248.Holding element 270 can rotate allowing bone anchors to insert between aperture 256,258 primary importance and the second position with respect to add ons 240, at second position place, holding element 270 overlaps to prevent with the bone anchors that inserts or limits holdfast and 256,258 withdraw from from the aperture.

Figure 12 A-12F shows spinal column segment SC and has another embodiment of the reaming guider 300 of reamer 120, reamer 120 for the preparation of vertebrae V 1, V2 to admit the projection 266,268 of add ons 240, so that in corresponding one front surfaces in projection 266, the 268 recessed vertebrae V 1, V2, to form not from stretch out slim of the front surface of vertebrae V 1, V2 or not have the implant assembly 260 of profile.Reaming guider 300 comprises the body 302 that can be positioned among the intervertebral disc space D, a pair of guide rib 304 that extends up and down from body 302 respectively, 306 and the central shaft 308 that extends proximally into near-end shank 310 from body 302.Shank 310 comprises that upper channel 312 and lower channel 314 pass the axle 122 of reamer 120 wherein with admittance.The near-end 126 of reamer 120 comprises for the boss of admitting T shape handle or other to install to be conducive to the rotation of reamer 120.Guide rib 304 comprises the first passage 316 that extends through wherein, and guide rib 306 comprises the second channel 318 that extends through wherein.Reamer 120 comprises the slender axles 122 of the reaming head 124 that extends to far-end.Reaming head 124 can be positioned among in the passage 316,318 corresponding one and is directed among corresponding vertebrae V 1, the V2 to form recess N1, the N2 shown in Figure 12 F, recess N1, N2 are used for admitting the projection 266,268 that is the add ons 240 of depression relation with the front surface of vertebrae V 1, V2, shown in Figure 11 A-11D.

Figure 13 A-13D shows add ons 240, and add ons 240 is attached to removedly that element 20 is positioned at respect to the implant assembly 260 in the positive profile position of vertebrae V 1, V2 with formation between vertebral body.In positive profile position, projection 266,268 front surfaces from vertebrae V 1, V2 stretch out forward, and corresponding one soleplate in the bone composition surface 244,246 direct engage vertebrae V1, V2.

Figure 14 A-14C shows the insertion apparatus 400 that joins the implant assembly 260 that comprises element 20 between add ons 240 and vertebral body to.Insertion apparatus 400 is included in and is similar to the slender axles 402 that extend in conjunction with between the near-end shank shown in the insertion apparatus 200 discussed above.Insert the insertion head 406 that apparatus 400 is included in the far-end of axle 402.Insert head 406 and be connected to axle 402 removedly, to allow assembled configuration for another embodiment of the insertion head of other embodiment of add ons.Yet, do not get rid of insertion head 406 and arrive the permanent attached of axle 402.Inserting head 406 comprises and axle 402 body 408 of longitudinal extension alignedly.Body 408 comprises first ramp way 410 and second ramp way 412, first ramp way 410 and second ramp way 412 are intersected with each other in body 408, make when with 260 assemblings of implant assembly, passage 410 at 256 places, aperture to far-end and on the downside of body 408 to proximal openings, and make passage 412 at 258 places, aperture to far-end and on the upside of body 408 to proximal openings.Passage 410,412 with the bone anchors aperture 256,258 of add ons 240 in the corresponding proximal extension portion of aliging and form, prepare apparatus and/or bone anchors 162,164 insertion with the guiding bone anchors.Insert head 406 and also comprise relative finger piece 414,416, finger piece 414,416 is positioned in the groove 271,272 on the opposite side of add ons 240 and along the sidewall 22 of element between

vertebral body

20,24 the outside surface of lateral face and enters in the groove 35,37.The location of finger piece 414,416 in groove guarantees that passage 410,412 is with respect to suitably locating and align in the aperture 256,258 of add ons 240.Inserter 400 also comprises can vertically move member (being similar to the member 220 of inserter 200), and this member can move with slit 418 compression bodies 408 longitudinally and makes finger piece 414,416 towards mobile so that implant assembly 260 is clamped between the two each other along axle 402.Element 20 and add ons 240 are positioned under the situation in the space between the vertebra between vertebral body, and ramp way 410,412 is used for guiding bone anchors 162,164 to pass aperture 256,258 and enter among corresponding vertebrae V 1, the V2 with required angle.

Figure 15 A-15D shows and is attached to element 20 between vertebral body removedly with another embodiment of the add ons 340 that forms implant assembly 360.Add ons 340 comprises slender body 342, and slender body 342 sizes are designed to extend and connect

sidewall

22,24 between the

sidewall

22,24 of element between vertebral body 20.Add ons 340 comprises towards and contacts the last bone composition surface 344 and relative sending down the fishbone composition surface 346 of corresponding one soleplate among vertebrae V 1, the V2.Composition surface 344,346 comprise respectively separately from its extension at least one tabular protruding 366,368.Add ons 340 also comprises towards outer surface 348 with relative towards interior surface 350.Co-operating member 352,354 stretches out and is configured to be received in receiving

portion

34,36 end 23,25 that is formed at element 20 between vertebral body from inner surface 350.In addition, add ons 340 comprises first aperture 356 and second aperture 358, first aperture 356 and second aperture 358 are positioned to pass corresponding in the projection 366,368, admit being used for implant assembly 360 is anchored to corresponding one bone anchors 162,164 of vertebrae V 1, V2 respectively, its protrusions 366,368 opposite sides at the median plane of add ons 340 and implant assembly 360 are offset.First aperture 356 tilts to head and towards sagittal plane, so that bone anchors 162 extends into epipyramis V1.Second aperture 358 tilts to afterbody and towards sagittal plane, so that bone anchors 164 extends into down vertebrae V 2.Holding element 370 is fixed to add ons 340 and is positioned between the aperture 356,358 on the outer surface 348.Holding element 370 can rotate allowing bone anchors to insert between aperture 356,358 primary importance and the second position with respect to add ons 340, at second position place, holding element 370 overlaps to prevent with the bone anchors that inserts or limits holdfast and 356,358 withdraw from from the aperture.

Utilize add ons 340, projection 366,368 turns forward with respect to body 342, as the clearest the illustrating of Figure 15 C, so that when bone anchors 162,164 during perpendicular to the inserting towards preceding surface of projection 366,368, bone anchors 162,164 tilts respectively up and down.This allows with manual techniques bone anchors 162,164 to be passed aperture 356,358 and inserts.In addition, in the front surface of vertebrae V 1, V2, can form recess so that projection 366,368 recessed vertebrae V 1, V2 in outer surface, to minimize or to eliminate add ons 340 from protruding towards preceding surface of vertebrae V 1, V2.

Figure 16 A-16D shows and can be attached to element 20 between vertebral body removedly with another embodiment of the add ons 440 that forms implant assembly 260.Add ons 440 is similar to add ons 240, but comprise at least one tabular protruding 466,468, at least one is tabular protruding 466,468 from the last bone composition surface 444 that turns forward with respect to body 442 and the corresponding extension the sending down the fishbone composition surface 446, as the clearest illustrating among Figure 16 C, so that when bone anchors 162,164 during perpendicular to the inserting towards preceding surface of projection 466,468, bone anchors 162,164 tilts respectively up and down.This allows with manual techniques bone anchors 162,164 to be passed aperture 456,458 and inserts, and does not have the risk of the soleplate that penetrates vertebrae V 1, V2.In addition, in the front surface of vertebrae V 1, V2, can form recess so that projection 466,468 recessed vertebrae V 1, V2 in outer surface, to minimize or to eliminate add ons 440 protruding from vertebrae V 1, V2.Add ons 440 comprises first aperture 456 and second aperture 458, first aperture 456 and second aperture 458 are positioned to pass corresponding in the projection 466,468, to admit corresponding one bone anchors 162,164 that is used for implant assembly 460 is anchored to vertebrae V 1, V2 respectively, its protrusions 466,468 median planes at add ons 440 and implant assembly 460 are in alignment with each other.First aperture 456 to head inclination and on sagittal plane, be parallel to or be roughly parallel to sagittal plane, so that bone anchors 162 extends into epipyramis V1.Second aperture 458 to afterbody tilt and on sagittal plane, be parallel to or be roughly parallel to sagittal plane, so that bone anchors 164 extends into down vertebrae V 2.

Figure 17 A-17D shows and is attached to element 20 between vertebral body removedly with another embodiment of the add ons 540 that forms implant assembly 560.Add ons 540 comprises the plate-like body 542 that has part 543 in the intervertebral disc, and part 543 is dimensioned to and extends between the

sidewall

22,24 of element between vertebral body 20 and

connection sidewall

22,24 in the intervertebral disc.Part 543 comprises towards and contacts the last bone composition surface 544 and relative sending down the fishbone composition surface 546 of corresponding one soleplate among vertebrae V 1, the V2 in the intervertebral disc.Composition surface 544,546 include from its extension at least one tabular protruding 566,568.Add ons 540 also comprises towards outer surface 548 with relative towards interior surface 550.Co-operating member 552,554 stretches out and is configured to be received in the

receiving portion

34,36 rear end 23,25 that is formed at element 20 between vertebral body from inner surface 550.In addition, add ons 540 comprises first aperture 556 and second aperture 557 that is positioned to pass projection 566 and the 3rd aperture 558 and the 4th aperture 559 that are positioned to pass projection 568.Aperture 556,557 is skew each other on the opposite side of the median plane of add ons 540, and aperture 558,559 skews each other on the opposite side of the median plane of add ons 540.In the aperture each admits bone anchors implant assembly 560 is anchored to corresponding among vertebrae V 1, the V2.First aperture 556 and second aperture 557 make bone anchors upwards and towards sagittal plane extend into epipyramis V1 to head and towards inclining towards each other.The 3rd aperture 558 and the 4th aperture 559 make bone anchors extend into down vertebrae V 2 to afterbody and towards sagittal plane to afterbody and towards inclining towards each other.Holding element 470 is fixed to add ons 440 and medially is positioned between the aperture 556,557,558,559 on the outer surface 548.Holding element 570 can rotate allowing bone anchors to insert between aperture 556,557,558,559 primary importance and the second position with respect to add ons 540, at second position place, holding element 570 overlaps to prevent with the bone anchors that inserts or limits holdfast and 556,557,558,559 withdraw from from the aperture, shown in Figure 17 B.

Figure 17 A-17D shows add ons 540, and add ons 540 is attached to removedly that element 20 is positioned at respect to the implant assembly 560 in the positive profile position of vertebrae V 1, V2 with formation between vertebral body.In positive profile position, projection 566,568 front surfaces from vertebrae V 1, V2 stretch out forward.In addition, projection is 566,568 away from turning forward towards outer surface 548, makes bone anchors can be guided through the aperture and enters vertebrae V 1, V2, and do not penetrate the soleplate of vertebrae V 1, V2.

It is contemplated that the reamer guider that is similar to shown in Figure 12 A-12E, it is configured to use in conjunction with implant assembly embodiment shown in Figure 13 A-13d, Figure 15 A-15D, Figure 16 A-16D and Figure 17 A-17D.It is contemplated that the insertion apparatus that is similar to shown in Figure 14 A-14C, it is configured to use in conjunction with implant assembly embodiment shown in Figure 15 A-15D, Figure 16 A-16D and Figure 17 A-17D.

Figure 18 show can and add ons described herein in any attached vertebral body between another embodiment of element 520.Element 520 is similar to element 20 between vertebral body discussed above between vertebral body, but comprises the body 522 with rear end surface 524, and rear end surface 524 extends between side surface 526,528 and connects side surface 526,528.Rear end surface 524 is included in receiving portion 530,532 wherein, receiving portion 530,532 with vertebral body between the

receiving portion

34,36 identical of element 20, be used for admitting removedly the co-operating member from the add ons that is attached to it.Body 522 lacks the cavity hatch at last bone composition surface 534 and sending down the fishbone composition surface 536 places, does not comprise this opening but do not get rid of.In a specific embodiment, between vertebral body element 520 by such as the tissue of skeleton or between incorporating period the tissue substituent of enhances skeletal growth and/or combination make.The add ons that is fixed to element 520 between vertebral body can be made by joining between vertebral body the more solid material of element 520 removedly to, to provide and the bone anchors that will be fixed to vertebrae V 1, the V2 platform of firm engagement more.Yet, should be appreciated that element and add ons can be made by any suitable biocompatible materials between the vertebral body that this paper discusses, and can be made to strengthen the function of each element by identical materials or different materials.The example of suitable material comprises titanium, titanium alloy, cobalt-chromium, cobalt-chromium alloy, PEEK, PEKK, carbon fiber-reinforced PEEK, carbon fiber-reinforced PEKK or other suitable metal or nonmetal biocompatible materials.Of course it is to be understood that the relative size that at (a plurality of) particular vertebra for the treatment of apparatus processing and anchor unit the ad-hoc location of the vertebra that joins to or structure to be revised parts.

It is contemplated that but be not required that, element can be provided in the external member of implant component between all those various vertebral bodys with different size as disclosed herein and have the add ons of different size and configuration.The surgeon can situation that intra-operative runs into based on intra-operative select and assemble additional components to element between vertebral body, in order to required implant assembly is provided.

Though described the various embodiment of the combination with special characteristic and/or parts, other embodiment that has from the combination of any feature of any embodiment discussed above and/or parts is possible.As used in this manual, singulative " ", " one ", " being somebody's turn to do " comprise that plural number refers to thing, unless context is specified clearly in addition.Therefore, for example, term " member " is intended to represent the combination of single member or member, and " material " is intended to represent one or more materials or their combination.In addition, term " near-end " and " far-end " refer to more close respectively and away from inserting medical implant and/or apparatus patient's operator's (for example, surgeon, internist, nurse, technician etc.) direction.For example, the part of at first inserting the medical apparatus and instruments in patient's body will be distal portions, and the relative part of this medical treatment device (for example, the part of close operator's medical treatment device) will be proximal part.

Though be shown specifically and described the present invention in accompanying drawing and aforementioned description, these are regarded as illustrative rather than restrictive in nature, should be appreciated that the expectation protection falls into all changes and the modification in the spirit of the present invention.

Claims

1. implant assembly that is used for spinal stabilization comprises:

Element between vertebral body, element comprises the body in the space that can be positioned between first and second vertebras between described vertebral body, element extends to relative rear end from front bulkhead between described vertebral body, the described body of element is included in the last bone composition surface and relative sending down the fishbone composition surface that extends between described front bulkhead and the described rear end between described vertebral body, when element between described vertebral body was positioned between described first and second vertebras, described upward bone composition surface and sending down the fishbone composition surface can engage with the corresponding soleplate of described first and second vertebras; And

Add ons, described add ons can be attached to the described rear end of the described body of described implant components, described add ons comprises towards outer surface and relative to interior surface towards the described rear end orientation of element between described vertebral body, described add ons also is included in and is used for the sending down the fishbone composition surface that engages the last bone composition surface of described first vertebra and be used for described second vertebra of joint when described add ons is attached to element between described vertebral body, one between wherein said vertebral body in the described inner surface of the described rear end of element and described add ons comprises having the receiving portion of the groove of opening up or down, and another between described vertebral body in element and the described add ons comprises co-operating member, described co-operating member can be located and be passed described slot opening, in order to rotate with respect to element between described vertebral body by making described add ons, so that described co-operating member moves along described groove, till element between described add ons and described vertebral body alignd, described add ons can be attached to element between described vertebral body.

2. implant assembly as claimed in claim 1, it is characterized in that, described add ons is included in the slender body that extends between the opposite side, when described add ons is attached between described vertebral body element, the relative lateral surface of element is alignd between described opposite side and described vertebral body, the described lateral surface of element includes groove between the described opposite side of described add ons and described vertebral body, described groove element between described add ons and described vertebral body cooperates and is in alignment with each other when aliging, in order to admit from inserting the finger piece that apparatus extends.

3. implant assembly as claimed in claim 1, it is characterized in that described add ons described goes up bone composition surface and described sending down the fishbone composition surface and include a plurality of projectioies from its extension to be used for engaging corresponding one soleplate of described first and second vertebras.

4. implant assembly as claimed in claim 1, it is characterized in that, described co-operating member comprises the cylinder form of the outer end with expansion and the female that extends around the outer end of described expansion, and described groove comprises the interior section of expansion with the outer end for the described expansion of admitting described co-operating member, and described groove comprises that also width reduces part to be used for admitting the described female of described co-operating member.

5. implant assembly as claimed in claim 1 is characterized in that:

Described one between described vertebral body in the described inner surface of the described rear end of element and described add ons comprises first and second receiving portions that are positioned at its opposite side place, and one described groove upward opening in the described receiving portion, the groove of another in the described receiving portion is then under shed; And

Described another between described vertebral body in element and the described add ons comprises a pair of co-operating member that is positioned at its opposite side place, described a pair of co-operating member can be located corresponding one that passes in the described slot opening, so that described add ons can be rotated with respect to element between described vertebral body, so that described co-operating member moves along described groove, till element between add ons and described vertebral body aligns.

6. implant assembly as claimed in claim 5 is characterized in that, element comprises first and second sidewalls that extend to described rear end from described front bulkhead between described vertebral body, and described sidewall is positioned on the opposite side of the cavity of the described body of element between described vertebral body.

7. implant assembly as claimed in claim 6 is characterized in that, described first receiving portion is arranged in the described rear end at described the first side wall place, and described second receiving portion is arranged in the described rear end of described second side-walls.

8. implant assembly as claimed in claim 1 is characterized in that:

Described add ons comprises the body that limits median plane, when in the described space that is positioned between described first and second vertebras, described body can align with described sagittal plane, and the described body of described add ons be configured to when described add ons join to element between described vertebral body and with described vertebral body between element be positioned at fully basically when aliging in the described space between described first and second vertebras; And

The described body of described add ons comprises first aperture and second aperture that extends through wherein, when described add ons join between described vertebral body element and with described vertebral body between element when aliging, described first aperture is configured to admit first bone anchors engaging described first vertebra, and described second aperture is configured to admit second bone anchors to engage described second vertebra.

9. implant assembly as claimed in claim 8 is characterized in that, described first aperture and second aperture of passing the described body of described add ons are tilting towards described sagittal plane on the direction of element between described vertebral body.

10. implant assembly as claimed in claim 8, it is characterized in that, described add ons comprises first group of detent projection, described first group of detent projection extends upward to be used for engaging the soleplate of described first vertebra from the part of the described body of described add ons around described first aperture, and described add ons comprises second group of detent projection, and described second group of detent projection extends to be used for engaging the soleplate of described second vertebra from the part of the described body of described add ons downwards around described second aperture.

11. implant assembly as claimed in claim 1 is characterized in that:

Described add ons comprises the body that limits median plane, when in the described space that is positioned between described first and second vertebras, described body can align with described sagittal plane, and the described body of described add ons be configured to when described add ons join to element between described vertebral body and with described vertebral body between element be positioned at fully basically when aliging in the described space between described first and second vertebras, described add ons also comprises from the described body upwardly extending first tabular projection of described add ons and the second tabular projection of extending downwards from the described body of described add ons; And

Described first and second projectioies of described add ons include the aperture that extends through wherein, and described aperture is angled, with the described add ons of box lunch join between described vertebral body element and with described vertebral body between element on the direction of element between described vertebral body, extending away from each other up and down when aliging, described first angled orifices is configured to admit first bone anchors engaging described first vertebra, and described second angled orifices is configured to admit second bone anchors to engage described second vertebra.

12. implant assembly as claimed in claim 11 is characterized in that, the described aperture of described first and second projectioies is in alignment with each other at described median plane.

13. implant assembly as claimed in claim 11 is characterized in that, the described aperture of described first and second projectioies is skew each other on the opposite side of described median plane.

14. implant assembly as claimed in claim 11, it is characterized in that, the described aperture of described first projection is included in the first pair of aperture that is offset on the opposite side of described median plane, and the described aperture of described second projection is included in the second pair of aperture that is offset on the opposite side of described median plane.

15. implant assembly as claimed in claim 11 is characterized in that element is included in the rear end surface that extends on the opposite side surfaces of described body between described vertebral body.